COVID-19 and Thromboembolism: FAQs
Patients with COVID-19, the disease caused by the SARS-CoV-2 virus, appear to have a higher thrombosis risk than other hospitalized or intensive care patients.3 The chart below provides information or resources on thromboembolism pertinent to COVID-19 patients. The information is presented in an FAQ format, with an emphasis on thrombosis prevention and treatment. Keep in mind that although there is little information specific to COVID-19 thrombosis management, there are some special considerations that may affect treatment decisions, including risk of hospital staff exposure to infected patients.
Abbreviations: ACS = acute coronary syndrome; aPTT = activated partial thromboplastin time; CV = cardiovascular; DAPT = dual antiplatelet therapy; DIC = disseminated intravascular coagulation; DOAC = direct oral anticoagulant; DVT = deep venous thrombosis; IPC = intermittent pneumatic compression; IVC = inferior vena cava; PCI = percutaneous coronary intervention; PEEP = positive end-expiratory pressure; PT = prothrombin time; VTE = venous thromboembolism; LMWH = low molecular-weight heparin; PE = pulmonary embolism; UFH = unfractionated heparin; ULN = upper limit of normal
Clinical Question |
Pertinent Information and Resources |
What is the proposed pathophysiology of venous thromboembolism as a complication of COVID-19? |
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How does COVID-19-associated thromboembolism present clinically? |
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For which COVID-19 patients should thromboembolism prophylaxis be considered, and how should it be provided? |
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How is thromboembolism in COVID-19 patients treated? |
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What are some general considerations for antithrombotic use of special relevance to COVID-19? |
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What are some select drug interactions between antithrombotics and drugs being investigated to treat COVID-19? |
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Project Leader in preparation of this clinical resource (360817): Melanie Cupp, Pharm.D., BCPS
References
- Wichmann D, Sperhake JP, Lutgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: a prospective cohort study. Ann Intern Med 2020 May 6. doi: 10.7326/M20-2003.
- Bikdeli B, Madhaven MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the art review. J Am Coll Cardiol 2020;75:2950-73.
- Moores LK, Tritschler T, Brosnahan S, et al. Prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19: Chest guideline and expert panel report. Chest 2020 Jun 2. doi: 10.1016/j.chest.2020.05.559.
- Rapkiewicz AV, Mai X, Carsons SE. Megakaryocytes and platelet-fibrin thrombo characterize multi-organ thrombosis at autopsy in COVID-19: a case series. EClinicalMedicine 2020 Jun 17;20:100434. doi: 10.1016/j.eclinm.2020.100434.
- Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 2020;18:1023-6.
- American Society of Hematology. COVID-19 and VTE/anticoagulation: frequently asked questions. July 20, 2020. https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation. (Accessed July 23, 2020).
- Clinical Resource, Comparison of Oral Anticoagulants. Pharmacist’s Letter/Prescriber’s Letter. December 2019.
- Spyropoulos AC, Levy JH, Ageno W, et al. Scientific and Standardization Committee communication: clinical guidance on the diagnosis, prevention and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020 May 27. doi: 10.1111/jth.14929.
- Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020 Mar 27. doi: 10.1111/jth.14817.
- American College of Cardiology. Thrombosis and COVID-19: FAQs for current practice. April 22, 2020. https://www.acc.org/latest-in-cardiology/articles/2020/04/17/14/42/thrombosis-and-coronavirus-disease-2019-covid-19-faqs-for-current-practice. (Accessed July 25, 2020).
- Barnes GD, Burnett A Allen A et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Haemost 2020 May 21. doi: 10.1007/s11239-020-02138-z.
- Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145-7.
Cite this document as follows: Clinical Resource, COVID-19 and Thromboembolism: FAQs. Hospital Pharmacist’s Letter/Prescriber’s Letter. August 2020.